Medical evacuations from the region of former Yugoslavia: The experience of 2 years

In September 1992, the International Organization for Migration(IOM), an intergovernmental humanitarian organization basedin Geneva, Switzerland, implemented the special medical programme(SMP) for the medical evacuation of war victims in former Yugoslavia.For inclusion into the SMP, patients must be victims of war,suffer from a serious medical condition with a favourable prognosis,not treatable locally, be stable enough to survive air traveland withstand delay between medical documentation and actualevacuation. As of August 1994,1,484 patients In need of secondarytreatment not locally available were evacuated to hospitalsin 31 countries. Most patients suffered from fractures, amputationsand nerve injuries. Seventy-two per cent originated from Bosnia-Herzegovina.This paper discusses various problems encountered, such as bureaucraticobstacles, ongoing armed conflict hampering humanitarian activities,lack of funding and the effects of the sustained media attention.     

Taurine Failed to Protect against the Embryotoxic Effects of Isotretinoin in the Rat

Taurine Failed to Protect against the Embryotoxic Effects ofIsotretinoin in the Rat AGNISH, N. D., RUSIN, G., AND DINARDO,B. (1990). Fundam. Appl. To.xicol. 15, 249–257. Experimentalevidence exists to indicate that retinoids may act as detergentsto disrupt biological membranes. Taurine, an amino sulfonicacid, has been shown to possess membrane-stabilizing and cytoprotectiveproperties. This study was undertaken to test whether taurinecoadministered with isotretinoin might be able to protect againstthe teratogenic effects of the retinoid. Our study failed tofind any support for this speculation. Whether challenged againsta 75 (mildly teratogenic) or 150 (very teratogenic) mg/kg/daydose of isotretinoin, taurine for the most part worsened theretinoid embryotoxicity. While in a few combinations taurinedecreased the re-sorption or malformation rate associated withisotretinoin, the decrease was, at best, marginal. In no casewas taurine able to decrease these rates to those noted in thecontrols.     

Accountability,Standards and Accreditation: Exploring the Link

In this paper, the author explores accountability, standards and acreditation as issues affecting health care professionals. The role of accreditation as a mechanism for accountability is described and the notion that accountability is a vital component of quality assurance discussed. The initiatives of particular health care professions in setting standards and promoting quality assurance amongst their members are explored. The author concludes that the health care professions have much to gain from involvement in the process of review and evaluation.     

Histochemical and morphological studies on mammalian epidermal peridermal granules

We performed morphological studies on the epidermal peridermal granules (PG) of newborn mice using histological, fluorescent and electron microscopic methods. PG appeared during the 17th to 18th day of foetal life, and remained in the outermost epidermal layers until 5 days after birth. PG were evenly distributed over the entire cutaneous surface of the mouse, except the tail. PG were found to contain protein and corresponded to sites of transglutaminase activity, but they were devoid of lipids and nucleic acids. They could be differentiated clearly from keratohyalin granules. Together, these studies suggest that PG represent a unique epidermal protein product that serves as a marker of late foetal development.     

Anaesthesia for emergency caesarean section

Summary. The Report on Confidential Enquiries into Maternal Deaths in England and Wales 1982–84 (Department of Health 1989) recommends early involvement of the anaesthetist in women having emergency caesarean sections and the use of epidural anaesthesia in preference to general anaesthesia. In an observational prospective study the need for emergency abdominal delivery could be anticipated in 87% of 360 consecutive emergency caesarean sections. Early establishment of epidural analgesia allowed extension, to an appropriate level for the surgery, in 70%. The duty anaesthetist accompanying the obstetric team on three wardrounds a day could be forewarned of anticipated problems in most women who are eventually delivered abdominally.     

Efficacy of Heparin in Peripheral Venous Infusion in Neonates

OBJECTIVE: To determine the efficacy of continuous, low-dose heparin infusion in prolonging peripheral venous catheter patency in neonates. DESIGN: Randomized, prospective study. SETTING: Level III neonatal intensive-care unit. PARTICIPANTS: 113 neonates requiring i.v. therapy. INTERVENTIONS: The neonates were randomly assigned to heparin (n = 63). The heparin group received 1/2 unit of heparin per milliliter of continuous intravenous infusate or intermittent heparin flush. MAIN OUTCOME MEASURES: Low-dose heparin infusion does not make a difference in the duration of peripheral venous catheter patency. The incidence of catheter-related complications in the heparin group is the same as for those receiving no heparin. RESULTS: The mean duration of catheter patency was 62.75 hours in the heparin group and 27.3 hours in the no-heparin group (p = .0001). The occurrence of infection, bleeding, and extravasation injury was zero in the sample studied. The incidence of phlebitis was 18 cases in 132 (13%) in the heparin group and 13 cases in 122 (10%) in the no-heparin group. According to chi-square analysis, the difference between groups was not statistically significant (p greater than .05). CONCLUSION: Low-dose heparin infusion in peripheral venous catheters in neonates increased the duration of intravenous catheter patency (p = .0001) without increased risks of bleeding, infection, phlebitis, or extravasation injury.     

Histopathology and ultrastructure of primary adrenocortical nodular dysplasia with Cushing''s syndrome

The characteristic adrenal lesions of five patients with bilateral primary adrenocortical nodular dysplasia and Cushing's syndrome developing in adolescence are presented histopathologically, and in two cases ultrastructurally. Two of the patients were siblings with additional extra-adrenal lesions such as pigmented spots on the face, myxoid cutaneous tumours and in one case familial cardiac myxoma. The adrenals were small with an uneven surface due to numerous small brown to black pigmented nodules in the inner cortex. The nodules were composed of eosinophilic giant cells filled with lipofuscin granules. The familial cases in addition revealed a pronounced disorganization of the adrenocortical architecture with capsular disruption and infiltration of periadrenal fatty tissue. The early onset of Cushing's syndrome in the second decade, the bilateral involvement of adrenal glands despite ACTH independence and the familial occurrence in combination with other peculiar rare lesions are strongly suggestive of a malformative process of the zona reticularis of the adrenal glands.     

Bioavailability of Aluminum from Drinking Water

Bioavailability of Aluminum from Drinking Water. FULTON, B.,JAW, S., AND JEFFERY, E. H. (1989). Fundam Appl. Toxicol. 12,144–150. Aluminum, present in our drinking water as hydroxideor sulfate, is limited by solubility to 2.5 mg/liter at pH 7.0.This study was carried out to determine if aluminum at dosestypically found in drinking water would accumulate in rat tissuesif a ligand such as citrate at neutral or acid pH is coadministered,or in the absence of citrate at acid pH. Al(OH)₃ or AlCl₃ wasgiven ad libitum in drinking water to male Sprague-Dawley ratsat 0, 0.1, 2.0, or 100 mg/liter, in 4 mM acetate, pH 3.2 (A),4 mM citrate, pH 2.6 (C), 4 mM citrate, pH 7.0 (7C), or distilledwater, pH 7.0(W). After 10 weeks, rats were killed and tissueswere wet-ashed in nitric acid for determination of aluminumby flameless atomic absorption. Copper, iron, and zinc weredetermined by flame atomic absorption. Metal ion concentrationsin tibia, brain, liver, blood, and kidney did not differ significantlybetween treatment groups. Aluminum accumulated in intestinalcells of all 100 mg Al/liter rats, with the C group accumulatingmore aluminum than the A or W groups. In the C group, intestinalaluminum content increased significantly in a dose-dependentmanner. Intestinal iron was decreased significantly in all the100 mg Al/liter groups. Intestinal copper was decreased in theW group at 100 mg Al/liter, with a trend toward a decrease inA and C groups. We conclude that at these low levels studied,aluminum accumulates in intestinal tissue, and that this accumulationis enhanced by citrate ligand. At 100 mg Al/liter, intestinaliron accumulation is decreased, and copper accumulation is marginallydecreased.     

Is group B streptococcal screening during pregnancy justified?

Summary. Twenty-eight per cent of women investigated during pregnancy were carriers of group B streptococci (GBS). The use of broth enrichment was the most significant factor in determining GBS carriage rates. GBS carriage decreased during pregnancy. Transmission of GBS from mother to baby was related to vaginal carriage but rectal carriage in pregnancy was the best predictor of maternal carriage at term. Rectal and vaginal swabs taken at 28 and 36 weeks correctly predicted 92% of intrapartum GBS carriage. Although accurate prediction of intrapartum GBS carriage is possible, mass screening for GBS in pregnancy is unlikely to be cost-effective in those countries with a low incidence of neonatal GBS sepsis.